E. coli outbreak, Europe

The outbreak of E. coli that Europe is currently experiencing is a different serotype than that associated with a chain of restaurants in the Pacific Northwest and West in 1993–“the outbreak that made E. coli famous” (my own quotable quote). Shortly before that, the Institute of Medicine had mentioned this bacterium as one of the emerging infections of public health importance. This serotype is O104:H4, which, like its more popular relative, is grouped under the heading “enterohemorrhagic E. coli” or EHEC. The bacterium produces a toxin which is similar to that produced by Shigella dysenteriae, and is referred to as Shiga-like toxin. In severe cases, hemolytic-uremic syndrome (HUS) may result. As a result of the toxin, hemolysis (destruction of red blood cells) may occur, ultimately resulting in kidney damage and renal failure. Supportive measures remain the mainstay of treatment, and since the 1993 outbreak, the consensus has been that antibiotics are counterproductive and may cause or increase the risk of HUS. Some recent evidence suggests that antibiotics such as imipenem or rifaximin may not increase the risk of HUS in the current outbreak, but this is the subject of current debate.

As of today (June 14, 2011), a total of 817 cases of HUS and 2508 non-HUS cases have been reported in the EU (see ProMED). The vast majority have been in Germany, particularly in the north, and epidemiologic investigation has demonstrated that a disproportionate number of cases report travel to northern Germany.  Epidemiologic investigation has been complicated by the fact that multiple layers of multiple governments have been involved, and a report by BBC suggested that this has made coordination difficult even within Germany.

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About epihealth

Professor of Epidemiology and Medical Geography, University of Washington, Seattle and Adjunct Prof, Depts of Medicine (Div of Infectious Diseases), Family Medicine, Health Services, and Global Health. President, Health Improvement and Promotion Alliance-Ghana www.hip-ghana.org Expertise in infectious diseases, epidemiology and clinical epidemiology, epi. of pain, community health, travel medicine, tuberculosis, disease control.
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